Provider Demographics
NPI:1962460881
Name:TOWN DENTAL, PA
Entity Type:Organization
Organization Name:TOWN DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-474-6133
Mailing Address - Street 1:425 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2038
Mailing Address - Country:US
Mailing Address - Phone:952-474-6133
Mailing Address - Fax:952-474-7361
Practice Address - Street 1:425 2ND ST
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2038
Practice Address - Country:US
Practice Address - Phone:952-474-6133
Practice Address - Fax:952-474-7361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty